Provider Demographics
NPI:1598356321
Name:MONTERO, MARIA DE LOS ANGELES (436PA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DE LOS ANGELES
Last Name:MONTERO
Suffix:
Gender:F
Credentials:436PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 U 40 LOMAS DE COUNTRY CLUB
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-1454
Mailing Address - Country:US
Mailing Address - Phone:787-226-5124
Mailing Address - Fax:
Practice Address - Street 1:20 U 40 LOMAS DE COUNTRY CLUB
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-1454
Practice Address - Country:US
Practice Address - Phone:787-226-5124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR436363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical